Minimising iatrogenic nerve injury in primary care.

Abstract

Nerve injuries usually present as pain, numbness, or weakness, and can have devastating consequences for patients. Procedures that are common in primary care can cause nerve injury. Iatrogenic nerve injuries are largely preventable by understanding nerve anatomical course and surface anatomy, and the risky interventions and regions. Most knowledge of nerve anatomical course is derived from early work on cadaver dissection, but modern imaging techniques more accurately map nerve anatomical course in living bodies. We provide an overview of nerve injuries in primary care, discuss updated nerve anatomical course and surface anatomy based on modern radiological evidence, and make recommendations to guide safer interventions in primary care. In New Zealand’s primary care treatment injury claims dataset there were 69 nerve injuries over 4 years (2% of primary care injuries).1 Venepuncture was the leading cause of nerve injury (27; 39%), followed by intramuscular injection (17; 25%), and steroid injection (15; 22%). Venepuncture injured the cutaneous nerve of the forearm (14), and the median (9) and radial (4) nerves; intramuscular injections injured the sciatic (11), lateral cutaneous (3), and axillary (3) nerves; steroid injections injured the median (12, carpal tunnel) and ulnar (3, medial epicondyle) nerves; intravenous cannulation in the forearm injured the superficial radial nerve (4); and minor surgical procedures injured the spinal accessory (3), common fibular (1), sural (1), and ilioinguinal nerves (1). Most nerve injuries were minor, but 17 (25%) were assessed as having major or serious potential consequences. …